Provider Demographics
NPI:1982657383
Name:EXCELLENT HOME MEDICAL EQUIPMENT CORP.
Entity Type:Organization
Organization Name:EXCELLENT HOME MEDICAL EQUIPMENT CORP.
Other - Org Name:EXCELLENT PHARMACY AND DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBARGANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-382-0116
Mailing Address - Street 1:18555 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6847
Mailing Address - Country:US
Mailing Address - Phone:305-382-0116
Mailing Address - Fax:305-382-0129
Practice Address - Street 1:9961 SW 142ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6844
Practice Address - Country:US
Practice Address - Phone:305-382-0116
Practice Address - Fax:305-382-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28010333600000X
FLPH244473336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1039177OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL5438180001Medicare UPIN
5438180001Medicare NSC